Effect of caffeine on LT, VT and HRVT.

UNLABELLED: Caffeine has many diverse physiological effects including central nervous system stimulation. Ventilatory threshold and a recently described heart rate variability threshold both have a relationship with autonomic control that could be altered by caffeine consumption. The purpose of this investigation was to determine the influence of caffeine on lactate, ventilatory, and heart rate variability thresholds during progressive exercise. Using a randomized placebo controlled, double-blind study design, 10 adults performed 2 graded maximal cycle ergometry tests with and without caffeine (5 mg·kg⁻¹). Respiratory gas exchange, blood lactate concentrations, and heart rate variability data were obtained at baseline and throughout exercise. RESULTS: At rest, caffeine (p<0.05) increased blood lactate, oxygen consumption, carbon dioxide production, and minute ventilation. For indices of heart rate variability at rest, caffeine increased (p<0.05) the coefficient of variation, while standard deviation, and mean successive difference displayed non-significant increases. During progressive exercise, minute ventilation volumes were higher in caffeine trials but no other parameters were significantly different compared to placebo tests. CONCLUSION: These data demonstrate the robustness of the lactate, ventilatory and heart rate variability thresholds when challenged by a physiological dose of caffeine.

Use of heart rate variability to estimate LT and VT.

The purpose of this study was to determine if changes in heart rate variability during incremental exercise could be used to estimate lactate threshold and ventilatory threshold in healthy adults. Twenty-four adults performed graded maximal cycle ergometry to volitional fatigue. Blood lactate, heart rate, RR interval, and respiratory gas exchange were monitored. Heart rate variability was analyzed using time domain indices (standard deviation and mean successive difference). A marked RR interval deflection point was found in the region of lactate threshold and ventilatory threshold, and was identified as the heart rate variability threshold. Mean differences between heart rate variability threshold, ventilatory threshold, and lactate threshold ranged from 0.06 +/- 0.3 to 0.12 +/- 0.2 L.min (-1). Correlations between the different measures ranged from 0.82 - 0.89. A small but significant difference was found between ventilatory threshold and lactate threshold (p < 0.05). There was not a significant difference between heart rate variability threshold and lactate threshold (p > 0.05), nor between heart rate variability threshold and ventilatory threshold (p > 0.05). The data suggest the heart rate variability threshold coincides with lactate threshold and ventilatory threshold during graded exercise and can be used for the detection of lactate threshold in healthy adults.

Post-exercise substrate utilization after a high glucose vs. high fructose meal during negative energy balance in the obese.

OBJECTIVE: To assess the effects of negative energy balance on the metabolic response of a meal containing either glucose or fructose as the primary source of carbohydrate after exercise in obese individuals in energy balance, or negative energy balance. RESEARCH METHODS AND PROCEDURES: Fourteen adults with mean body mass index (BMI) 30.3 +/- 1 kg/m2, age 26 +/- 2 years, and weight 93.5 +/- 5.4 kg, adhered to an energy-balanced (EB) or a negative energy-balanced (NEB) diet for 6 days. On Day 7, subjects exercised at 70% VO2peak for 40 minutes then consumed either high glucose (50 g of glucose, HG) or high fructose (50 g of fructose, HF) liquid meal. Substrate utilization was measured by indirect calorimetry for 3 hours. Blood samples were collected before exercise and 0, 30, 60, 120, and 180 minutes after consuming the meal. RESULTS: The HG produced 15.9% greater glycemic (p < 0.05) and 30.9% larger insulinemic (p < 0.05) responses than the HF under both EB and NEB conditions. After the NEB diet, carbohydrate and fat oxidation did not differ for HG and HF. In contrast, carbohydrate oxidation increased 31%, and fat oxidation decreased 39% with HF compared with HG after the EB diet. Thus, HF and HG consumed after exercise produced marked differences in macronutrient oxidation when obese subjects followed an EB diet, but no difference when adhering to a NEB diet. DISCUSSION: The data suggest that the use of fructose in supplements/meals may provide no additional benefit in terms of substrate utilization during a weight loss program involving diet and exercise.

Determining bone and total body mineral content from body density and bioelectrical response spectroscopy.

We hypothesized that one could assess total body mineral (TBM) and bone mineral content (BMC) from measurements of body density and bioelectrical response spectroscopy (BRS)-determined total body water by using a three-compartment (3C) model. We compared TBM and BMC computed from measurements of water (2H2O dilution or BRS) and body density (underwater weighing) with [4-compartment (4C)] and without (3C) mineral (dual X-ray absorptiometry) in 15 women and 16 men. BRS used multifrequency or single-frequency estimates of water. Mean differences between the 3C and 4C models ranged from -6.1 to 2.2%. Correlations between models were 0.82-0.91. Standard errors of the estimate of 8.5-9.3% were within the range of those previously reported, i.e., 4.9-13%. Use of BRS did not significantly decrease the strength of the correlations between the models. A significant mean difference (only in women) was found only with 3C single-frequency BRS estimates of TBM and BMC. We concluded that investigators can assess TBM and BMC 3C multifrequency BRS estimates in men and women.

Clinical pathways for family-oriented developmental care in the intensive care nursery.

The physiologic and neurodevelopmental benefits of developmentally sensitive nursing care for high-risk infants have been well documented. The remaining challenge is to find ways to introduce developmental care principles into busy intensive care nurseries. The article discusses the development of three clinical pathways designed around five areas for developmental intervention: environmental organization, structuring of nursing care, feeding, family involvement, and family education. Each pathway incorporated developmental principles appropriate for a different level of care; the level III pathway was designed for acutely ill or very premature infants, the level II pathway for infants recovering from acute illness or older premature infants, and the level I pathway for full-term infants. Introduction of the developmental care pathways had an immediate positive impact in the tertiary level intensive care nursery at Allegheny General Hospital.

Nutrition, endocrinology, and body composition during space flight.

Space flight induces endocrine changes that perturb metabolism. This altered metabolism affects both the astronauts' body composition and the nutritional requirements necessary to maintain their health. During the last 25 years, a combination of studies conducted on Skylab (the first U.S. space laboratory), U.S. Shuttle flights, and Soviet and Russian flights provides a range of data from which general conclusions about energy and protein requirements can be drawn. We have reviewed the endocrine data from those studies and related it to changes in body composition. From these data it appears that protein and energy intake of astronauts are similar to those on Earth. However, a combination of measures, including exercise, appropriate diet, and, potentially, drugs, is required to provide the muscle health needed for long duration space flight.

Adaptation of the doubly labeled water method for subjects consuming isotopically enriched water.

The use of doubly labeled water (DLW) to measure energy expenditure is subject to error if the background abundance of the oxygen and hydrogen isotope tracers changes during the test period. This study evaluated the accuracy and precision of different methods by which such background isotope changes can be corrected, including a modified method that allows prediction of the baseline that would be achieved if subjects were to consume water from a given source indefinitely. Subjects in this study were eight women (4 test subjects and 4 control subjects) who consumed for 28 days water enriched to resemble drinking water aboard the United States space shuttle. Test subjects and control subjects were given a DLW dose on days 1 and 15, respectively. The change to an enriched water source produced a bias in expenditure calculations that exceeded 2.9 MJ/day (35%), relative to calculations from intake-balance. The proposed correction based on the predicted final abundance of 18O and deuterium after equilibration to the new water source eliminated this bias, as did the traditional use of a control group. This new modified correction method is advantageous under field conditions when subject numbers are limited.

Assessing total body and extracellular water from bioelectrical response spectroscopy.

We developed and validated assessments for total body water (TBW) and extracellular water (ECW) by using two resistance values of a new electric circuit model (CM) (two resistors; a capacitor and an inductor) with or without body mass. Fluid shifts occurring after 40 min of supine rest did not increase the validity of either estimate. CM estimates were valid; r = 0.941 to 0.969, low SE of estimates of 1.15-2.28 kg, nonsignificant mean differences (CM - dilution; %delta = -0.4 to 1.3%) that were close to the expected measurement errors for TBW (+/- 1%) and ECW (+/- 5%), and Bland-Altman pairwise comparisons that showed equivalence between methods. The CM estimates of TBW and ECW had marginally better validity than the previously published bioimpedance models. The advantage of the CM model is its assessments of multiple fluid spaces and that it does not require gender-specific equations. We conclude that CM estimate of TBW is acceptable, whereas further validation is needed before the ECW estimate should be used in a clinical or research setting.

Comparison of ground-based and space flight energy expenditure and water turnover in middle-aged healthy male US astronauts.

Energy requirements during space flight are poorly defined because they depend on metabolic-balance studies, food disappearance, and dietary records. Water turnover has been estimated by balance methods only. The purpose of this study was to determine energy requirements and water turnover for short-term space flights (8-14 d). Subjects were 13 male astronauts aged 36-51 y with normal body mass indexes (BMIs). Total energy expenditure (TEE) was determined during both a ground-based period and space flight and compared with the World Health Organization (WHO) calculations of energy requirements and dietary intake. TEE was not different for the ground-based and the space-flight periods (12.40 +/- 2.83 and 11.70 +/- 1.89 MJ/d, respectively), and the WHO calculation using the moderate activity correction was a good predictor of TEE during space flight. During the ground-based period, energy intake and TEE did not differ, but during space flight energy intake was significantly lower than TEE; body weight was also less at landing than before flight. Water turnover was lower during space flight than during the ground-based period (2.7 +/- 0.6 compared with 3.8 +/- 0.5 L/d), probably because of lower fluid intakes and perspiration loss during flight. This study confirmed that the WHO calculation can be used for male crew members' energy requirements during short space flights.

Assessing total body protein, mineral, and bone mineral content from total body water and body density.

We hypothesized that investigators could assess bone mineral content (BMC), total body mineral (M), and protein (P) from body water (W) and density (DB) based on the theory of W. E. Siri (Advances in Biological and Medical Physics, 1956, p. 239-280 and Techniques for Measuring Body Composition, 1961, p. 223-224) for body composition analysis. Siri used one or more of the body components and the densities of the body, fat (F), W, M, and P to estimate one of the remaining fractional masses. We compared M, BMC, P. F, and fat-free mass (FFM) in 31 subjects (15 women and 16 men) computed from measurements of W and DB with [4-compartment (4C) model] and without [3-compartment (3C) model] BMC (from dual X-ray absorptiometry). 4C model P was calculated by difference (P = FFM - W - M). Mean difference (P > 0.05) ranged from 0.1 to 0.8%. Correlations [+/- standard error of estimate (%)] between 4C and 3C model values were significant (r = 0.907 +/- 8.8, 0.907 +/- 8.7, 0.969 +/- 6.6, 0.998 +/- 2.0, and 0.999 +/- 0.7% for M, BMC, P, F, and FFM, respectively). We concluded that investigators can assess M, BMC, and P from W and DB.

Incidence, timing, and follow-up of periventricular leukomalacia.

Screening cranial ultrasounds were performed on 115 very low birthweight infants during the first week of life. Fourteen infants (12%) developed changes of periventricular leukomalacia. All 14 weighted 1100 g or less at birth. Eight infants' initial studies were normal, four had intraventricular hemorrhage, and two had periventricular echo densities. Cystic periventricular leukomalacia developed between 17 and 104 days of age and occurred later in those infants whose initial study was normal. There were tone abnormalities in 11 of the 12 infants who received developmental follow-up. Severe cognitive delays were common in the older infants. This study demonstrates the need for late ultrasound screening even in the presence of initial normal ultrasound examinations.

Energy expenditure during antiorthostatic bed rest (simulated microgravity).

Few studies have addressed the interaction between energy balance and lean body mass in healthy subjects during spaceflight or its simulations. We used doubly labeled water to measure total energy expenditure (TEE) in nine healthy adult men during two 7-day periods, once before and once during a 10-day head-down bed-rest period. Mean TEE was 21% less during than before bed rest; however, neither basal (BEE) nor resting (REE) energy expenditures changed, implying that the lesser TEE resulted from a reduction in physical activity. During the bed-rest period, energy intake was 563 +/- 280 kcal/day higher than TEE (P < 0.05) but body weight, fluid balance, BEE, and REE did not change relative to before bed rest. However, the small but statistically significant increase in body fat (0.44 +/- 0.67 kg, P < 0.05) during the bed-rest period suggests that body weight alone does not accurately reflect changes in energy balance during antiorthostatic bed rest.

Physical performance is maintained in women consuming only foods used on the U.S. Space Shuttle.

In-flight reductions in caloric intake, body weight, lean body mass (LBM), aerobic capacity, and other measures of physical performance have been consistent findings in the U.S. and Russian space programs. The diet provided for astronauts in space has been suggested as a possible contributor to these changes because food selection, preparation, and storage facilities are limited on spacecraft. In this ground-based study, consuming only foods used on the Space Shuttle for 28 d did not affect aerobic capacity, LBM, or measures of muscle strength or endurance in 12 healthy women (ages 28-47 years). However, normal consumption patterns were affected by restriction to the Space Shuttle diet, namely a proportional increase in carbohydrate consumed, with compensatory decreases in protein and fat. These results suggest that physical performance and LBM can be maintained under normal gravity conditions in active women who consume a Space Shuttle food-system diet for 28 d.

Metabolic energy required for flight.

This paper reviews data available from U.S. and U.S.S.R. studies on energy metabolism in the microgravity of space flight. Energy utilization and energy availability in space seem to be similar to those on Earth. However, negative nitrogen balances in space in the presence of adequate energy and protein intakes and in-flight exercise, suggest that lean body mass decreases in space. Metabolic studies during simulated (bed rest) and actual microgravity have shown changes in blood glucose, fatty acids, and insulin levels, suggesting that energy metabolism may be altered during flight. Future research should focus on the interactions of lean body mass, diet, and exercise in space and their roles in energy metabolism during space flight.

Variability of some objective measures of physical activity.

The purpose of this study was to determine how many days subjects should be monitored to provide an estimate of habitual physical activity in employed men engaged in a wide range of occupations. Caloric intake, movement recorders (accelerometers and pedometers), and heart rate were the measurements studied in 30 subjects who were monitored during their waking hours for 7 continuous days. A repeated measures ANOVA showed no significant difference between days (P > 0.05) for any of the measures when only weekdays were compared. However, when weekend days were included a majority of the measures showed a significant F-ratio (P < 0.05). An estimate was made of the number of days required to measure a 7-d period with less than 5% error. The average for all the different measures was 4.9 d. It appears that at least 5 or 6 d are needed to minimize the intra-individual variance a reasonable degree. Weekdays as well as weekend days need to be included.

Comment on heart rate recording in field studies.

This is a report of our experience using the Uniq Heart Watch for recording the heart rate in epidemiologic settings. Relatively few heart rates are missed during occupational and leisure activities. However the mean daily heart rate among subjects is somewhat variable so that several week days and Saturday and Sunday should be monitored to obtain a representative daily average.